Examining Rehab 2 With Dr. Drew – Episode 2

Our scene-specific blog commentary on Celebrity Rehab with Dr. Drew continues. Below, the doctor talks about the main points of the episode: kicking, kicking and screaming (on Jeff’s part) and the ball of extremeness that is Gary. Drew also gives some insight on the difficulty of treating people in front of cameras and why he hates being mistaken for a producer on set.

A major theme of this episode was detox. The footage of Amber is pretty insane.

She had a very tough withdrawal and that’s going from one milligram of Suboxone. What’s interesting is that medicine is supposed to be the salvation for opiate addicts and yet you’re looking down the barrel of how problematic that is. It’s supposed to be a medicine used for out-patient detox, and it makes things so easy for patients. Well, she couldn’t get off it, you see how tough it is for her to stop. Opiate addicts need to stop doing opiates, period. There never will be a kinder, easier way for opiate addicts. She was on a tiny dose and going from that to zero, you see how horrible it is.Tawny says that opiate users tend to think that detox is going to be worse than it is.

She’s right. Particularly methadone addicts have what’s called a pathological fear of withdrawal. The withdrawal is bad. Amber’s was bad, but that’s not as bad as it gets. But then, it’s over in three days and that’s that. What was impressive to me with Amber, I don’t know how well it translated on camera but in person this was really striking: her sympathetic nervous system was so turned on. She was lit up like a candle. Her pupils were just blown, they were the size of saucers. She’s was so affected by the withdrawal. It was very striking to see. Without her complaining, I could just see it.

When we see her in the common area at night, she’s obviously struggling, but after that, the next morning, she seems fine.

That’s the way that withdrawal is: it waxes and wanes. Usually about 4 in the afternoon, that’s when people have trouble with it. I don’t know why, but it’s sort of the common bad time. For Amber, it was later.

Is the anticipation part of the withdrawal process?

It’s worse than the withdrawal. I could get anybody off drugs, but here’s the thing: opiate addicts have a pathological distortion that all they have to do is get off opiates and they’ll be fine. Well, Amber knows that’s not the case, because she’s been through this enough times. The drive to do the opiates is what the addiction is about. Even when you’re off the opiates, your brain is forever altered. That’s the main priority in your life. You may not even be aware that you’re seeking opiates, but your brain is.We’re introduced to Luisha this episode. Can you talk bout her?

Luisha works with Shelley, Bob and I. We needed somebody that’s strong because this is a tough group. We needed someone who could withstand anything and still be OK regardless of the onslaught. Luisha and Shelly are a very powerful team. They’re different in their approaches, but they’re very, very powerful.

It seems that from the get-go, Luisha takes more heat than Shelly ever has.

Well, Luisha can withstand more. Shelly invests. She gets very involved with people. She’s kind of like me in that way. As such, when people are having tough experiences, she gets affected by it more deeply. Luisha is much more of our staid, unmovable point. But she knows addiction very, very well. Addicts want to know that you care, and sometimes they feel like someone who’s cold and tough doesn’t care, even though Luisha does. So addicts will get angry about that. They want you to care about them. I understand that.

Tawny also wonders if Gary’s in the right facility. Was it ever a question of yours that he was in need of additional or different treatment than rehab?

Well, when someone’s admitted to a chemical-dependency unit, they have to be an addict. That’s the criteria for admission. In our assessment of Gary, it was clear that he was an addict, he had all these consequences of addiction. It just wasn’t clear what stages his addiction was in, and whether or not there were psychiatric pathologies and neurological pathologies that would make it impossible to treat him at this level of care. But even before I met this squad of patients, I was prepared to increase psychiatric and psychological services. I just had a feeling. I found last season they could tolerate that, and I wasn’t sure at first how cameras would affect things. It was new territory. But since I found out they could tolerate it, I really wasn’t concerned that Gary was in the wrong unit. I felt like we could figure it out.

You do that with the help of Dr. Sophy. Is he someone you worked with before?

Yes. I know him well. He’s top-notch. He is a blessing to our team. He runs the largest foster-care system in the country. He’s the director of the L.A. County Department for Child and Family Services. He’s not only a board-certified psychiatrist, he’s a board-certified family practitioner, which is something I look for in psychiatrists: to know what it is to be a doctor. He understands the complexity of the medical and psychiatric, which is always at play in addiction. And he’s an extremely capable guy. In my opinion, he singlehandedly turned around a foster care system that was frankly a catastrophe to one of the shining examples of the L.A. County mental health system.

Gary has this notion of elevated status, and while that’s annoying, it also nets results: he helps convince Jeff to stay out of what he perceives to be duty.

Gary is helpful to his peers. He ends up being more helpful than he could have imagined, but it’s not the way he thought it was going to go. You can be a patient and be of service to your peers, but you also have to be an open, vulnerable, honest person yourself. This is just the beginning of Gary’s waxing and waning relationship with his peers, where he’s a problem and he’s a help.

He also brings up the cameras with you, and I know that’s not your area of concern. As a doctor, what’s it like being the middleman between the patients and the producers?

It’s stressful. We become representative of the producing team, and yet we’re not producing on set. We’re just trying to treat patients. At the same time, we’re all under the sway of a television production. We all signed up for the television production. That’s the weird layer in this thing. I want to ignore all that. I don’t want anything to do with that. I just want to do treatment. And yet it lurks around. The TV part is there sometimes. It fools with my ability to read what the patients are experiencing, whether they’re editing themselves or bulls***ting for the cameras. But more than that, their ability to trust me can be compromised by this feeling of, “Hey, is he really with us, or is he with the production guys?” I hate that.

That sort of mistrust is nothing new to you, though, right? As a highly visible doctor, I’m sure you get, “Oh, he’s just some quack” all the time.

I don’t get much of that from people I’m taking care of. I think once people come to me, they have a predisposition to be willing to trust me, and once they involved they understand that’s what I’m doing. But I’ll tell you what it does play on: addicts always have an issue with trust. It is the major issue: getting someone to trust you. So this set-up becomes a reason for them to pull back. It’s a challenge.

Jeff’s up to his old tricks again this episode. He says, “Just because I’m here, it doesn’t mean my drug problem’s going away.” That’s a very bleak outlook.

Well, here’s one thing I’ve learned: don’t assume what an addict says in the moment is going to persist. No matter what they declare, you just have to say, “Whatever.” You keep it moving forward and see how it goes for the next couple of weeks.

You say that having Vicki next door is added stress. The situation of her being a door’s width away is less than ideal, right?

It’s less than ideal, but it’s manageable. I was less disturbed by this than the episode would suggest. To me, this was no different than Vicki visiting like she always did last season. That was always disruptive and I’m sure it would have been this season, too.

For more on this week’s episode, watch Drew’s video recap here, and check out the screen shots below: